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Bernstein Medical - Center for Hair Restoration
Hair Restoration Answers

How Do You Make Recipient Sites in a Hair Transplant?

Q: How do you make the recipient sites in a hair transplant? — N.P., New Delhi, India

A: I make the recipient sites using 19-, 20-, 21- and 22-gauge needles. The higher the number, the finer the needle. The hairline is done with a 21-gauge, which is really very tiny. Eyebrow sites are created with a 22-. When one draws blood in a routine blood test, an 18-g needle is used and, of course, there are no residual marks. The instruments we use are significantly finer than this.

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Hair Restoration Answers

What Are Differences Between Follicular Unit Transplantation, Follicular Unit Extraction, and Ultra-refined FUHT?

Q: What is the difference between the following ways of doing hair transplants: Follicular Unit Transplantation (FUT), Ultra-refined FUHT, and Follicular Unit Extraction (FUE)? — N.D., Meatpacking, N.Y.

A: Please see the Bernstein Medical – Center for Hair Restoration website as it explains Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) in detail.

In brief, with FUT, follicular units are obtained from the microscopic dissection of a donor strip that has been removed from the back of the scalp. In FUE, the doctor attempts to remove intact follicular units directly from the scalp via a small round instrument called a punch.

Ultra Refined FUHT (Follicular Unit Hair Transplantation) is term that Pat Hennessey uses on his Hair Transplant Network. It refers to using very tiny recipient sites, carefully dissected follicular unit grafts, and large hair transplant sessions in FUHT procedures.

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Hair Restoration Answers

In FUT Hair Transplant, How Important Are Microscopes?

Q: I went to a hair transplant doctor for a consultation for my hair loss and he said that it was not that important to use microscopes for hair transplants. I had heard that it was. What’s the deal? — V.F., Hell’s Kitchen, N.Y.

A: It is extremely important to use microscopes when performing hair transplants. It is the only way that follicular units, the naturally occurring groups of hair follicles, can be isolated from the donor tissue without damaging them.

Other techniques, such as magnifying loops and back-lighting are not as precise. Using microscopically dissected follicular units in hair transplants has been the main advance that has allowed doctors to move away from the older mini-micrografting hair restoration techniques to the current procedure that can produce totally natural results.

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Hair Restoration Answers

What is Follicular Unit Extraction and What Other Terms are Associated with the Procedure?

Q: I am considering having an FUE procedure and have heard the phrases topping, capping, and tethering as part of the procedure. What do all these terms mean? — C.C., Hell’s Kitchen, N.Y.

A: These are all terms that refer to the types of injury that can occur to grafts during a follicular unit extraction procedure.

In FUE, a sharp instrument (or sharp instrument followed by a blunt one) is used to separate follicular units from the surrounding donor tissue. Forceps are then used to remove the follicular units from the scalp.

Topping occurs in the first step when the doctor accidentally cuts off the top of the graft so that the remainder of the graft cannot be removed.

Capping occurs when the doctor grabs a graft with forceps and the top of the graft (the epidermis and upper dermis) pulls off, leaving the rest of the graft behind.

Tethering occurs when the bottom of the graft is still attached to the deeper tissues after the first step causing the follicular unit to pull apart during extraction.

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Hair Restoration Answers

How Does Densitometry Help Diagnose Hair Loss?

Q: Dr. Bernstein, I was reading about a densitometer on your website. What is it and what is it actually used for? — Z.A., Westchester, NY

A: The hair densitometer was introduced to hair restoration surgeons by Dr. Rassman in 1993. It is a small, portable, instrument that has a magnifying lens and an opening of 10mm2.

To use it, the doctor clips the hair short (~ 1-mm) and the instrument is then placed on the scalp. The doctor counts the total number of hairs in the field, looks at the number of hairs per follicular unit and assesses the diameter of the hair, looking in particular for abnormal levels of miniaturization (decreased hair shaft diameter caused by the effects of DHT).

The densitometer can increase the accuracy of the diagnosis of genetic hair loss by picking up early miniaturization.

It can also better assess a person’s donor hair supply, thus helping to determine which patients are candidates for a hair transplant.

Densitometry has helped us define the conditions of diffuse patterned and unpatterned hair loss (DPA and DUPA) and help to refine the diagnosis of hair loss in women.

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Hair Restoration Answers

Can I Have a Hair Transplant if My Scalp is Tight from Prior Surgery?

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

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Bernstein Medical In The News

Dr. Bernstein’s Lecture On FUT Hair Transplantation

Dr. Bernstein's Lecture on FUT Hair Transplant SurgeryDr. Bernstein, a renowned teacher, lecturer, and surgeon, is bringing his state-of-the-art hair restoration techniques directly to patients. His lecture on Follicular Unit Transplantation (FUT) includes a historical review of hair transplant techniques, from the out-dated “hair plugs” and “cornrows” to refined FUT procedures. Watch the lecture to see images of surgical tools, illustrations of surgical techniques, and before and after patient photos.

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